1. Cardiac Output Monitoring in Cardiac Surgery with Cardiopulmonary Bypass K. Lebedinski, A. Vetchinkin St. Petersburg

2. Circulatory Failure After Cardiac Surgery With CPB HypovolemiaVasoplegia: Rewarming Rewarming SIRS after CPB SIRS after CPB Drug or blood reaction Drug or blood reaction Primary Low Cardiac Output: Ventricular dysfunction Ventricular dysfunction Surgical problems Surgical problems

3. Circulatory Failure: Diagnosis Cardiac Output? Vascular Tone? Preload?

4. CO: measurement SVR: calculation Preload: measurement The Sources of Principal Hemodynamic Variables

5. Clinical group: 32 ASA III-IV male patients, aged 40-75 Surgery: Elective CABG and/or valve replacement with CPB Methods: CO estimation by 6 different methods, in all 913 pair data

6. Method: Conventional (pulmonary artery) thermodilution, N=246 S/5 General Electric, USA

7. Method: Partial CO 2 -rebreathing based on differential form of Fick equation, N=473 NICO 2 Novametrix, USA

8. PiCCO Pulsion, Germany Method: transpulmonary thermodilution followed by continuous pulse wave contour analysis, N=416

9. Diamant-MRussia Method: Impedance Cardiography with on-line Computer Analysis (Bioimpedance Monitoring), N=428

10. Sonoline G60S Siemens, Germany Method: Transesophageal echocardiography (TEE), N=113

11. Method: Adolf Fick principle (1870), N=150

12. Correlation Between Methods: Before CPB The best: CTD, TPTD, CO 2 and IC The best: CTD, TPTD, CO 2 and IC The worst: Fick and TEE The worst: Fick and TEE

13. Correlation Between Methods: After CPB Correlations between CTD, TPTD and CO 2 remained stable Correlations between CTD, TPTD and CO 2 remained stable

14. Correlation Between Methods: After CPB IC became inaccurate! IC became inaccurate!

15. Correlation Between Methods: After CPB What about Fick and TEE? Small amount of data - ?... What about Fick and TEE? Small amount of data - ?...

16. Conclusions: The most relevant cardiac output monitoring methods in cardiac surgery with cardiopulmonary bypass are conventional and transpulmonary thermodilution and CO 2 partial rebreathing.The most relevant cardiac output monitoring methods in cardiac surgery with cardiopulmonary bypass are conventional and transpulmonary thermodilution and CO 2 partial rebreathing. Impedance cardiography, acceptable in non- CPB cases, became inaccurate after the bypass.Impedance cardiography, acceptable in non- CPB cases, became inaccurate after the bypass. Transesophageal EchoCG and Fick method demonstrate poor accuracy in clinical settings.Transesophageal EchoCG and Fick method demonstrate poor accuracy in clinical settings.

17. Thank you for the attention!